Dataset Information

Health-related and psychosocial concerns about transplantation among patients initiating dialysis.

ABSTRACT:

Background and objectives

Disparities in kidney transplantation remain; one mechanism for disparities in access to transplantation (ATT) may be patient-perceived concerns about pursuing transplantation. This study sought to characterize prevalence of patient-perceived concerns, explore interrelationships between concerns, determine patient characteristics associated with concerns, and assess the effect of concerns on ATT.

Design, setting, participants, & measurements

Prevalences of 12 patient-perceived concerns about pursuing transplantation were determined among 348 adults who recently initiated dialysis, recruited from 26 free-standing dialysis centers around Baltimore, Maryland (January 2009-March 2012). Using variable reduction techniques, concerns were clustered into two categories (health-related and psychosocial) and quantified with scale scores. Associations between patient characteristics and concerns were estimated using modified Poisson regression. Associations between concerns and ATT were estimated using Cox models.

Results

The most frequently cited patient-perceived concerns were that participants felt they were doing fine on dialysis (68.4%) and felt uncomfortable asking someone to donate a kidney (29.9%). Older age was independently associated with having high health-related (adjusted relative risk, 1.35 [95% confidence interval, 1.20 to 1.51], for every 5 years older for those ? 60 years) or psychosocial (1.15 [1.00 to 1.31], for every 5 years older for those aged ? 60 years) concerns, as was being a woman (1.72 [1.21 to 2.43] and 1.55 [1.09 to 2.20]), having less education (1.59 [1.08 to 2.35] and 1.77 [1.17 to 2.68], comparing postsecondary education to grade school or less), and having more comorbidities (1.18 [1.08 to 1.30] and 1.18 [1.07 to 1.29], per one comorbidity increase). Having never seen a nephrologist before dialysis initiation was associated with high psychosocial concerns (1.48 [1.01 to 2.18]). Those with high health-related (0.37 [0.16 to 0.87]) or psychosocial (0.47 [0.23 to 0.95]) concerns were less likely to achieve ATT (median follow-up time 2.2 years; interquartile range, 1.6-3.2).

Conclusions

Patient-perceived concerns about pursuing kidney transplantation are highly prevalent, particularly among older adults and women. Reducing these concerns may help decrease disparities in ATT.

SUBMITTER: Salter ML

PROVIDER: S-EPMC4220760 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Health-related and psychosocial concerns about transplantation among patients initiating dialysis.

Salter Megan L ML Gupta Natasha N King Elizabeth E Bandeen-Roche Karen K Law Andrew H AH McAdams-DeMarco Mara A MA Meoni Lucy A LA Jaar Bernard G BG Sozio Stephen M SM Kao Wen Hong Linda WH Parekh Rulan S RS Segev Dorry L DL

Clinical journal of the American Society of Nephrology : CJASN 20140911 11

<h4>Background and objectives</h4>Disparities in kidney transplantation remain; one mechanism for disparities in access to transplantation (ATT) may be patient-perceived concerns about pursuing transplantation. This study sought to characterize prevalence of patient-perceived concerns, explore interrelationships between concerns, determine patient characteristics associated with concerns, and assess the effect of concerns on ATT.<h4>Design, setting, participants, & measurements</h4>Prevalences o ...[more]

PMID: 25212908

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Dataset Information

Health-related and psychosocial concerns about transplantation among patients initiating dialysis.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Publications

Health-related and psychosocial concerns about transplantation among patients initiating dialysis.

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